Preliminary Study On The Dynamic Changes And Localization Of Cognitive Function After Acute Cerebral Infarction

Objective: Ischemic stroke has a high incidence in China,and its mortality and disability rates are high.Cognitive dysfunction is one of the common complications of stroke.Post-stroke cognitive impairment(PSCI)not only seriously reduces the quality of life of patients,but also shortens the survival time of patients.Previous studies have focused on the incidence of PSCI,and there are few studies on the dynamic changes of cognitive function in different periods after stroke.Therefore,this study explored the independent influencing factors of cognitive dysfunction after acute cerebral infarction,the dynamic changes of cognitive function after acute cerebral infarction and the correlation between different infarction sites and cognitive impairment.Methods: A prospective enrollment of 291 patients with acute cerebral infarction admitted to the Northern Jiangsu People’s Hospital,from January 2017 to March 2018,respectively,within 2 weeks(baseline),3 months and 6 months after infarction.Assessment of cognitive function and daily living ability of patients included: Simple Intelligence Mental Status Scale(MMSE),Montreal Cognitive Assessment(MoCA),Daily Living Ability Scale(ADL),and Cognitive Function Scale for Older Adults(Cog-12)),recording demographic factors,vascular risk factors,and clinical features that may affect cognitive function after acute cerebral infarction.Groups were divided according to the presence or absence of cognitive impairment.The data were analyzed by SPSS25.0.The dynamic changes of cognitive function after acute cerebral infarction and the influencing factors of post-stroke cognitive impairment were discussed.The correlation between different infarct sites and cognitive impairment was analyzed.Results: A total of 291 patients with acute ischemic stroke,20 patients with severe aphasia and dysarthria;20 of whom were unable to complete the assessment due to superior lateral muscle strength below grade 3;10 patients had major depression after or after stroke;25 patients with severe illness and conscious disorders;65 patients died or refused follow-up evaluation,and a total of 151 patients completed baseline,3 months,and 6 months of follow-up.The incidence of PSCI at baseline,at 3 months after stroke,and at 6 months after stroke were 55.6%,43.7%,and 41.7%.The MMSE,MoCA,ADL,and Cog-12 scores at 3 months and 6 months after stroke were higher than those at baseline(P<0.05),and the cognitive assessment at 6 months after stroke was compared with 3 months after stroke.The scores were slightly improved,but there was no statistical difference(P>0.05).Dynamic changes in MoCA sub-items: In terms of naming,scores at 3 months and 6 months after stroke were higher than those at baseline(P<0.05).There was also an increase in 6 months and 3 months after stroke(P<0.05).In terms of visual space and executive ability,attention and delayed recall,the scores at 3 months and 6 months after stroke were higher than those at baseline(P<0.05).There was no significant difference between the 6 months and 3 months after stroke(P>0.05).In terms of orientation,the score for stroke at 3 months was higher than that at baseline(P<0.05).There was a slight increase in the 6 months after stroke compared with baseline,and there was no significant difference between the 6 months and 3 months after stroke(P>0.05).In terms of language,the scores at 6 months after stroke were higher than those at baseline(P<0.05).There was no significant difference between the 3 months after stroke and the baseline,and 6 months and 3 months after stroke(P>0.05).In terms of abstraction,there was no significant difference between baseline and post-stroke.The incidence of cognitive impairment in patients with different cerebral infarction was different.The incidence of cognitive impairment in patients with acute cerebral infarction in the frontal lobe,temporal lobe,basal ganglia and thalamus was high,respectively 88.9%,85.7%,83.3%,80.0%.There were significant differences between the patients with different infarction sites in the visual space and executive function,attention,language,and delayed recall(P<0.05).There were no significant differences between the patients with different infarction sites in the three aspects of naming,abstraction and orientation(P>0.05).Multivariate logistic regression analysis showed that age,MoCA(baseline),first NIHSS score,and stroke progression were independently associated with PSCI at 6 months after stroke(P<0.05).Compared with the normal cognitive group,the older,higher initial NIHSS score and stroke progression increased the risk of PSCI(P<0.05).Conclusion: The incidence of PSCI is high after acute cerebral infarction and PSCI is involved in the main cognitive domain of cognitive function.The cognitive function of most patients with ischemic stroke increased 6 months after stroke,and some patients improved their cognitive function within 3 months after stroke,especially in terms of naming,visual space and executive ability,attention and delayed recall.obvious.The incidence of cognitive impairment in different infarcts is different,and patients with cerebral infarction in the basal ganglia,frontal lobe,temporal lobe,and thalamus are more likely to develop cognitive impairment.Among them,Visual space and executive dysfunction were more pronounced in infarcts of temporal lobe and occipital lobe;attention deficit and language dysfunction were most evident in temporal lobe infarction;memory dysfunction was more pronounced in frontal lobe infarction.Age,MoCA(baseline),first NIHSS score,and stroke progression were independent factors influencing PSCI 6 months after stroke.Older,higher initial NIHSS scores and stroke progression are risk factors for PSCI.